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A m e r i c a n

J o i n t

C o m m i t t e e

o n

C a n c e r

Prostate Cancer Staging

7t h E D I T I O N

Definitions

IIA

IIB

III
IV

T
T1ac
T2a
T12a
T1ac
T1ac
T2a
T2a
T2b
T2b
T2c
T12
T12
T3ab
T4
Any T
Any T

N
N0
N0
N0
N0
N0
N0
N0
N0
N0
N0
N0
N0
N0
N0
N1
Any N

M
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M1

PSA
PSA <10
PSA <10
PSA X
PSA <20
PSA 10<20
PSA 10<20
PSA <20
PSA <20
PSA X
Any PSA
PSA 20
Any PSA
Any PSA
Any PSA
Any PSA
Any PSA

Gleason
Gleason 6
Gleason 6
Gleason X
Gleason 7
Gleason 6
Gleason 6
Gleason 7
Gleason 7
Gleason X
Any Gleason
Any Gleason
Gleason 8
Any Gleason
Any Gleason
Any Gleason
Any Gleason

pT2 Organ confined


pT2a Unilateral, one-half of
one side or less
pT2b Unilateral, involving more than
one-half of side but not both sides
pT2c Bilateral disease
pT3 Extraprostatic extension
pT3a Extraprostatic extension
or microscopic invasion
of bladder neck4
pT3b Seminal vesicle invasion
pT4 Invasion of rectum, levator
muscles, and/or pelvic wall

TX Primary tumor cannot be assessed


T0 No evidence of primary tumor
T1 Clinically inapparent tumor neither
palpable nor visible by imaging
T1a Tumor incidental histologic finding
in 5% or less of tissue resected
T1b Tumor incidental histologic finding
in more than 5% of tissue resected
T1c Tumor identified by needle
biopsy (for example, because
of elevated PSA)
T2 Tumor confined within prostate1
T2a Tumor involves one-half
of one lobe or less
T2b Tumor involves more than one-half
of one lobe but not both lobes
T2c Tumor involves both lobes
T3 Tumor extends through
the prostate capsule2
T3a Extracapsular extension
(unilateral or bilateral)
T3b Tumor invades seminal vesicle(s)
T4 Tumor is fixed or invades adjacent
structures other than seminal
vesicles, such as external sphincter,
rectum, bladder, levator muscles,
and/or pelvic wall (Figure A)

Regional Lymph Nodes (N)


CLINICAL

NX Regional lymph nodes


were not assessed
N0 No regional lymph node metastasis
N1 Metastasis in regional
lymph node(s)
PATHOLOGIC

pNX Regional nodes not sampled


pN0 No positive regional nodes
pN1 Metastases in regional node(s)
Distant Metastasis (M)5

M0
M1
M1a
M1b
M1c

No distant metastasis
Distant metastasis
Nonregional lymph node(s)
Bone(s)
Other site(s) with or
without bone disease

Notes
1 Tumor found in one or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c.
2 Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is classified not as T3 but as T2.
3 There is no pathologic T1 classification.
4 Positive surgical margin should be indicated by an R1

descriptor (residual microscopic disease).

5 When more than one site of metastasis is present, the

most advanced category is used. pM1c is most advanced.

Financial support for AJCC


7th Edition Staging Posters
provided by the American Cancer Society

6 When either PSA or Gleason is not available, grouping should be determined

by T stage and/or either PSA or Gleason as available.

Printed with permission from the AJCC.

CLINICAL

A N AT O M I C S TAG E / P R O G N O S T I C G R O U P S 6

Group

Pathologic (pT)3

Copyright 2009 American Joint Committee on Cancer

Figure A. T4 tumor invading adjacent structures other


than seminal vesicles, such as bladder, rectum, levator
muscles, and/or pelvic wall.

Primary Tumor (T)